Department of Future Medicine and Innovative Medical Information, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan.
J Am Coll Surg. 2010 Jun;210(6):927-33. doi: 10.1016/j.jamcollsurg.2010.01.032. Epub 2010 Apr 28.
The aim of this study was to report on the early experiences using a real-time 3-dimensional (3D) virtual reality navigation system with open MRI for breast-conserving surgery.
We developed a real-time 3D virtual reality navigation system with open MRI, and evaluated the mismatch between the navigation system and real distance using a 3D phantom. Two patients with nonpalpable MRI-detected breast tumors underwent breast-conserving surgery under the guidance of the navigation system. An initial MRI for the breast tumor using skin-affixed markers was performed immediately before excision. A percutaneous intramammary dye marker was applied to delineate an excision line, and the computer software "3D Slicer" generated a real-time 3D virtual reality model of the tumor and the puncture needle in the breast. Excision of the tumor was performed in the usual manner along the excision line indicated with the dye. The resected specimens were carefully examined histopathologically.
The mean mismatch between the navigation system and real distance was 2.01 +/- 0.32 mm when evaluated with the 3D phantom. Under guidance by the navigation system, a percutaneous intramammary dye marker was applied without any difficulty. Fiducial registration errors were 3.00 mm for patient no. 1, and 4.07 mm for patient no. 2. Histopathological examinations of the resected specimens of the 2 patients showed noninvasive ductal carcinoma in situ. The surgical margins were free of carcinoma cells.
Real-time 3D virtual reality navigation system with open MRI is feasible for safe and accurate excision of nonpalpable MRI-detected breast tumors. Long-term outcomes of this technique should be evaluated further.
本研究旨在报告使用实时三维（3D）虚拟现实导航系统结合开放式磁共振成像（MRI）进行保乳手术的早期经验。
我们开发了一种实时 3D 虚拟现实导航系统结合开放式 MRI，并使用 3D 体模评估了导航系统与真实距离之间的不匹配。两名患有不可触及的 MRI 检测到的乳腺肿瘤的患者在导航系统的指导下接受了保乳手术。在切除前，对乳腺肿瘤进行了初始的皮肤贴附标记物的 MRI 检查。在乳腺内应用经皮染料标记物来描绘切除线，然后计算机软件“3D Slicer”生成肿瘤和乳腺内穿刺针的实时 3D 虚拟现实模型。按照染料指示的切除线进行肿瘤的常规切除。仔细进行切除标本的组织病理学检查。
使用 3D 体模评估时，导航系统与真实距离之间的平均不匹配为 2.01 +/- 0.32 毫米。在导航系统的指导下，经皮乳腺内染料标记物的应用没有任何困难。患者 1 的基准注册误差为 3.00 毫米，患者 2 的基准注册误差为 4.07 毫米。2 名患者的切除标本组织病理学检查均显示为非浸润性导管原位癌。手术切缘无癌细胞。
结合开放式 MRI 的实时 3D 虚拟现实导航系统对于安全准确地切除不可触及的 MRI 检测到的乳腺肿瘤是可行的。该技术的长期结果应进一步评估。
